The Moderating Influence of School Adult Connectedness on Adolescent Dating Violence and Mental Health

BACKGROUND

Adolescent dating violence (ADV) continues to be a health concern. Most previous research has examined physical and or sexual ADV with little attention to verbal violence.

METHODS

Drawing on the social-ecological framework, the current study examined the moderating influence of school adult connectedness on experiences of verbal only, physical and/or sexual violence (combination ADV), and mental health outcomes among 11th graders (n = 31,459) in one Midwestern state.

RESULTS

Overall, 24.0% and 28.8% of adolescents met thresholds for depression and anxiety symptoms, respectively. Rates of mental health symptoms were higher among adolescents reporting ADV compared to those who did not report experience of ADV. In logistic regressions, higher level of school adult connectedness was associated with lower odds of depressive and anxiety symptoms, respectively. In moderation analyses, school adult connectedness was protective for mental health outcomes regardless of ADV experience.

CONCLUSION

Adolescent dating violence-including verbal violence alone-can be traumatic for young people. Schools can leverage the protective nature of school adult connection to promote mental health for all students, including adolescents who have experienced ADV. Incorporating trauma-informed education practice of providing unconditional positive regard toward adolescents might be 1-way schools can support adolescents in cultivating healthy relationships and well-being.

Exploring the intersection of multiple social determinants of health and disordered eating behaviors in a population-based sample in the United States

OBJECTIVE

Disordered eating behaviors (DEBs) have long-term, deleterious effects on health and are more prevalent among socially marginalized groups, likely as a result of systemic inequities across social determinants of health (SDoH). This exploratory study aimed to identify subgroups of emerging adults characterized by main and interactive associations between SDoH and two forms of DEB (binge eating, extreme unhealthy weight control behaviors).

METHOD

Participants (n = 1568; age 22.2 ± 2.1 years) from the United States were drawn from the EAT 2010-2018 longitudinal study. Conditional inference tree (CIT) analyses derived main and intersecting SDoH related to DEB across 33 input variables collected during adolescence and emerging adulthood.

RESULTS

The binge eating CIT revealed five subgroups (prevalence: 6.3-23.2%) shaped by variables collected during emerging adulthood: appearance-based teasing (p < .001), financial difficulty (p = .003), gender (p < .001), and everyday discrimination (p = .008). The CIT results for extreme unhealthy weight control behaviors derived six subgroups (prevalence: 2.3-45.5%) shaped by weight teasing (p < .001) and gender (p < .001) during emerging adulthood and public assistance (p = .008) and neighborhood safety (p = .007) in adolescence.

DISCUSSION

This exploratory study revealed distinct subgroups of emerging adults with varying DEB prevalence, suggesting that variability in DEB prevalence may be partially explained by intersecting SDoH during adolescence and emerging adulthood. Hypothesis-driven research and replication studies are needed to further explore the associations between SDoH and DEB during emerging adulthood.

PUBLIC SIGNIFICANCE STATEMENT

Disordered eating behaviors are common among young people in the United States and have long-term health consequences. This exploratory study identified subgroups of young people, characterized by combinations of social inequities (e.g., financial difficulties, teasing). Results highlight high-risk subgroups of emerging adults that should be examined further in hypothesis-driven research.

Stigmatizing policies’ influence on HIV risk through their effect on internalized homonegativity and health behaviors among men who have sex with men in Europe

Background

Men who have sex with men (MSM) in Europe are most affected by HIV disparities. Complex systems theory proposes that many health behaviors and risks arise from numerous cascading and interacting processes. Our aim was to explore how stigmatizing policies at the European country-level create pathways to HIV risk and disparities among MSM in Europe.

Methods

We used data from the 2017 European Men Who Have Sex with Men Internet Survey (EMIS-2017). The anonymous online survey recruited 126,090 European MSM. We assessed condom use with steady & non-steady partners as the outcome. Condom use was categorized from zero to 10 (10 or more partners). Abuse was scored zero to three and internalized homonegativity from zero to six. We used the International Gay and Lesbian Association's Rainbow Index as the main predictor, which ranks European countries' laws and policies regarding LGBTQ+ legal protections from zero (worst) to 100 (best). We used structural equation and multi-level modeling for analyses.

Results

The mean Rainbow Index score was 50.8 with a range from 6 to 88. The Rainbow Index scores were the highest in Western European (mean=62.5), then Central European (mean=45.9), then Eastern Europe (mean=21.4) (p &lt; 0.000). Unadjusted regression models suggested that for every one-unit improvement in the Rainbow Index the number of condomless sexual acts with steady sexual partners was reduced [β=-0.0012, 95% CI (-0.0016, -0.0009)]. The unadjusted structural equation model showed that the relationship between the Rainbow Index and condom use with steady partners was mediated by 30% because of internalized homonegativity (p &lt; 0.000).

Conclusions

The policy context influences HIV risk, especially through the policies' effects on condom use. HIV research and prevention efforts must recognize that structural determinants can shape people's risk for HIV and that the best individual and local efforts may be undermined by structural factors such as policies.

Associations between bullying involvement, protective factors, and mental health among American Indian youth

Bullying involvement as a victim or perpetrator is associated with depression and suicidality, and American Indian (AI) youth experience a disproportionately high rate of these mental health issues. This study assessed whether AI young people involved in bullying were more likely to experience negative mental health problems than AI youth who were not involved in bullying, and identified protective factors that might support this particularly vulnerable population. Data come from 1,409 8th, 9th, and 11th Grade AI students who completed the 2013 Minnesota Student Survey. Logistic regression models estimated associations between bullying involvement and internalizing symptoms and suicidality. Selected protective factors (internal assets, empowerment, positive student-teacher relationships, and feeling safe at school) were also examined as independent variables. All forms of bullying perpetration and victimization were associated with increased risk for mental health problems (odds ratio [OR]: 1.57-2.87). AI youth who reported higher levels of protective factors were less likely to report internalizing symptoms and suicidality even in the presence of bullying involvement. For example, AI youth who reported high levels of internal assets had half the odds of reporting internalizing symptoms compared with those with low levels of internal assets (OR = 0.53, confidence interval [CI] 0.38, 0.74). Findings suggest that, similar to a general sample of students, bullying-involved AI students are significantly more likely to experience mental health problems. Promoting school as a safe place and incorporating culturally relevant programming to promote internal assets such as positive identity, social competence, and empowerment among AI students could help reduce the negative effects of bullying involvement. (PsycINFO Database Record

Parent conversations about healthful eating and weight: associations with adolescent disordered eating behaviors

IMPORTANCE

The prevalence of weight-related problems in adolescents is high. Parents of adolescents may wonder whether talking about eating habits and weight is useful or detrimental.

OBJECTIVE

To examine the associations between parent conversations about healthful eating and weight and adolescent disordered eating behaviors.

DESIGN

Cross-sectional analysis using data from 2 linked multilevel population-based studies.

SETTING

Anthropometric assessments and surveys completed at school by adolescents and surveys completed at home by parents in 2009-2010.

PARTICIPANTS

Socioeconomically and racially/ethnically diverse sample (81% ethnic minority; 60% low income) of adolescents from Eating and Activity in Teens 2010 (EAT 2010) (n = 2793; mean age, 14.4 years) and parents from Project Families and Eating and Activity in Teens (Project F-EAT) (n = 3709; mean age, 42.3 years). EXPOSURE Parent conversations about healthful eating and weight/size.

MAIN OUTCOMES AND MEASURES

Adolescent dieting, unhealthy weight-control behaviors, and binge eating.

RESULTS

Mothers and fathers who engaged in weight-related conversations had adolescents who were more likely to diet, use unhealthy weight-control behaviors, and engage in binge eating. Overweight or obese adolescents whose mothers engaged in conversations that were focused only on healthful eating behaviors were less likely to diet and use unhealthy weight-control behaviors. Additionally, subanalyses with adolescents with data from 2 parents showed that when both parents engaged in healthful eating conversations, their overweight or obese adolescent children were less likely to diet and use unhealthy weight-control behaviors.

CONCLUSIONS AND RELEVANCE

Parent conversations focused on weight/size are associated with increased risk for adolescent disordered eating behaviors, whereas conversations focused on healthful eating are protective against disordered eating behaviors.

Abstract P2-10-16: Quantitative HER3 protein expression and PIK3CA mutation status in matched samples from primary and metastatic breast cancer tissues and correlation with time to recurrence

Background: HER3 is thought to play a prominent role in resistance to HER2-directed breast cancer therapies. Recent data suggest that HER3 levels also influence HER2-normal breast tumor biology. HER3 and PI3K signaling are linked in that in HER3 signaling activates PI3K and inhibition of PI3K activity can upregulate HER3 expression. Here, we measured quantitative HER3 protein expression levels and PIK3CA mutation status in matched tissues from the primary tumor and site of metastasis to assess correlations with time to recurrence.

Methods: 44 pairs (8 HER2+ by HERmark®) of matched tissues from the primary tumor and the site of metastasis were evaluated for HER3 protein expression using a sensitive, quantitative assay for HER3 protein expression in FFPE tissue sections (VeraTag®). Matched samples were also evaluated for quantitative HER2 expression (HERmark) and for PIK3CA mutations at exon 9 (E542K and E545K) and exon 20 (H1047R).

Results: HER3 protein expression at the metastatic site was largely independent of HER3 levels at the primary site (Spearman p = 0.50) in contrast to HER2 expression (Spearman p = 0.0004). HER3 expression in the primary tumor correlated with time to recurrence (TTR) (HR = 2.0 per 2-fold increase in HER3; p &lt; 0.0001). Conversely, HER3 expression measured at the site of metastasis was not correlated with TTR (p = 0.55). Estrogen receptor negative tumors were less likely to have PIK3CA mutations (p = 0.023). In cases of primary tumors with PIK3CA mutations, no reversions to wild-type PIK3CA were observed in the metastatic sites. In metastatic tumors, mutations detected in the primary tumor as well as new mutations were observed. A gain of an exon 9 mutation at the metastatic site correlated with shorter TTR (HR = 2.5; p = 0.043). Excluding the 8 samples that were HER2+ by HERmark, longer TTR was observed for patients with PIK3CA mutations in the primary tumor (HR = 0.47; p = 0.042), which is consistent with previous reports. Interestingly, the longer TTR for those with PIK3CA mutations appeared to be dependent on quantitative HER3 protein level (interaction p = 0.065).

Conclusions: HER3 protein expression in matched primary and metastatic breast cancer tissues were unrelated. This may indicate that HER3 protein is influenced by the different tumor microenvironments of the primary and metastatic sites. PIK3CA mutations were either maintained or acquired at metastatic sites. Both low HER3 protein expression and the presence of PIK3CA mutations in the primary tumor but not the metastatic tumor were associated with longer TTR. These observations suggest that HER3 protein expression may be an important prognostic factor for breast cancer progression.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-16.

Latino values in the context of palliative care: illustrative cases from the Family Focused Grief Therapy trial

BACKGROUND

Clinicians meet a variety of ethnicities among patients and families in hospice programs. This article focuses on Latino families.

METHODS

Within a controlled trial of family therapy in the context of palliative care, 17 families identified as Hispanic. Five were examined qualitatively herein.

RESULTS

A synopsis of each family's narrative is presented here. Patterns of strong family loyalty (Familismo), the gender roles of Machismo and Marianismo, the importance of family tradition, expectations about caregiving, and the place of faith and religion emerged as prominent and able potentially to impact on the therapy.

CONCLUSIONS

Family therapists need to be thoughtful about cultural issues as they strive to support families.

Biomedical engineering education through global engineering teams

Most industrial projects require a team of engineers from a variety of disciplines. The team members are often culturally diverse and geographically dispersed. Many students do not acquire sufficient skills from typical university courses to function efficiently in such an environment. The Global Engineering Teams (GET) programme was designed to prepare students such a scenario in industry. This paper discusses five biomedical engineering themed projects completed by GET students. The benefits and success of the programme in educating students in the field of biomedical engineering are discussed.

The link between body dissatisfaction and self-esteem in adolescents: similarities across gender, age, weight status, race/ethnicity, and socioeconomic status

PURPOSE

The present study examined whether the cross-sectional association between body dissatisfaction and low self-esteem varies across gender, age, body weight status, race/ethnicity, and socioeconomic status (SES). We also examined the association longitudinally.

METHODS

A school-based survey of eating, weight, and related attitudes was conducted with a diverse sample of adolescents aged 11-18 years (N = 4,746). Height and weight were measured in the schools at Time 1. Participants were resurveyed through mails 5 years later (Time, 2; N = 2,516).

RESULTS

The relationship between body dissatisfaction and self-esteem was strong and significant in both boys and girls (all p values < .0001), and did not differ significantly between genders (p = .16), or between the middle school and high school cohorts in either boys (p = .79) or girls (p = .80). Among girls, the relationship between body dissatisfaction and self-esteem was strong, but did vary across weight status, race/ethnicity, and SES (all p values = .0001-.03). The relationship was nonsignificant in underweight girls (p = .36), and weaker but still significant among black, Asian, and low SES group girls (all p values < .0001) in comparison to white and high SES group girls. Among boys, the association did not differ significantly across demographic groups (all p values = .18-.79). In longitudinal analyses, the strength of the association did not change significantly as adolescents grew older.

CONCLUSIONS

Findings indicate that body dissatisfaction and self-esteem are strongly related among nearly all groups of adolescents. This suggests the importance of addressing body image concerns with adolescents of all backgrounds and ages.

Maternal and adolescent report of mothers' weight-related concerns and behaviors: longitudinal associations with adolescent body dissatisfaction and weight control practices

OBJECTIVE

This population-based study examined mothers' weight-related concerns and behaviors (weight status, weight dissatisfaction, dieting, and encouraging child to diet) at baseline, as assessed by both mothers and adolescents, and associations with adolescents' body dissatisfaction and weight control practices 5 years later.

METHODS

Adolescents and their mothers (n = 443 pairs) were surveyed in 1998-1999; adolescents were resurveyed in 2003-2004.

RESULTS

Baseline maternal report of higher levels of her weight-related concerns/behaviors was associated with greater body dissatisfaction in girls 5 years later, controlling for adolescent weight status and other covariates. Baseline maternal report of weight-related concerns/behaviors was also associated with greater prevalence of trying to lose weight in both boys and girls 5 years later. Baseline adolescent report of higher maternal weight-related concerns/behaviors was associated with a higher prevalence of trying to lose weight 5 years later in girls.

CONCLUSIONS

These findings highlight the importance of mothers' weight-related concerns and behaviors for adolescents' weight-related outcomes.

Acute anti-emetic withdrawal associated with a hemorrhagic cerebellar arteriovenous malformation

We present a 67-year-old right-handed male with a brachium pontis arteriovenous malformation on continuous anti-emetic therapy who demonstrated acute withdrawal symptoms after the abrupt discontinuation of ondansetron, a 5-HT(3) receptor antagonist. Removal of anti-emetic therapy led to the development of extreme flushing and tremor, but subsequent return of ondansetron resulted in the resolution of these symptoms. This is the first clinical report demonstrating acute withdrawal from an anti-emetic agent and we further highlight the need for future studies evaluating not only arterial supply with pressure gradients and anatomical location, but also the association with periventricular venous drainage, venous drainage stenosis, and mass effect from venous stasis as this may contribute partly to the sensitivity of the serotonergic receptors seen here.

Peer harassment and disordered eating

In this paper, we review existing literature regarding peer harassment and its association with a range of weight-related attitudes and behaviors. We conceptualize peer harassment to include traditionally defined bullying behavior, other social and relational forms of bullying, as well as teasing and other verbal harassment. Weight-based teasing is particularly relevant to weight-related issues and has been associated with clinical eating disorders, unhealthy weight control behaviors, and weight-related attitudes, such as body dissatisfaction. Studies using both clinical samples of eating disorder patients and general samples of college students or adolescents have demonstrated these relations. Emerging issues in this field, including teasing by family members, research with males, teasing and weight-related issues in developing countries, and the measurement of teasing experience are also discussed. Interventions with healthcare providers, parents, school personnel, and policy can contribute to the prevention of teasing and its associated weight-related attitudes and behaviors.

Obesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later?

OBJECTIVE

To determine if adolescents who report dieting and different weight-control behaviors are at increased or decreased risk for gains in body mass index, overweight status, binge eating, extreme weight-control behaviors, and eating disorders 5 years later.

DESIGN

Population-based 5-year longitudinal study.

PARTICIPANTS

Adolescents (N=2,516) from diverse ethnic and socioeconomic backgrounds who completed Project EAT (Eating Among Teens) surveys in 1999 (Time 1) and 2004 (Time 2).

MAIN OUTCOME MEASURES

Weight status, binge eating, extreme weight control, and self-reported eating disorder.

STATISTICAL ANALYSIS

Multiple linear and logistic regressions.

RESULTS

Adolescents using unhealthful weight-control behaviors at Time 1 increased their body mass index by about 1 unit more than adolescents not using any weight-control behaviors and were at approximately three times greater risk for being overweight at Time 2 (odds ratio [OR]=2.7 for girls; OR=3.2 for boys). Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control (OR=6.4 for girls; OR=5.9 for boys) and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics (OR=2.5 for girls; OR=4.8 for boys) 5 years later, compared with adolescents not using any weight-control behaviors.

CONCLUSIONS

Dieting and unhealthful weight-control behaviors predict outcomes related to obesity and eating disorders 5 years later. A shift away from dieting and drastic weight-control measures toward the long-term implementation of healthful eating and physical activity behaviors is needed to prevent obesity and eating disorders in adolescents.

Changing channels for tobacco control with youth: developing an intervention for working teens

Worksites represent an untapped resource for reaching teens with tobacco control messages, given that 80% of teens have held at least one job by the time they graduate from high school. This paper presents formative research findings from a methods development study aimed at designing and testing a tobacco control intervention targeting working teens. Formative research included qualitative methods as well as quantitative data from a cross-sectional survey of teens employed in 10 participating grocery stores. Contrary to our a priori hypothesis, smoking rates among employed youth in this study were not higher than statewide averages and most of the teen workers were still in school, indicating that worksite interventions, at least in this setting, represent an alternative or adjunct to school-based programs, but do not necessarily capture a unique population. Employed teen tobacco use patterns and work characteristics that emerged from our formative research are presented in this paper, and may be useful in planning future worksite interventions for employed teens.

Substance use behaviors among college students with same-sex and opposite-sex experience: results from a national study

OBJECTIVES

This study seeks to describe the population of college students with same-sex sexual experience and determine if these students report more substance use than their peers with only opposite-sex experience.

METHODS

Questionnaires were completed by a national random sample of college students on 119 campuses in 1999. A total of 10,301 sexually active students were categorized as having only opposite-sex, only same-sex, or both-sex partners, and their smoking, binge drinking, and marijuana use behaviors were compared.

RESULTS

Students who report same-sex sexual experiences comprise 6.1% of respondent. Women with both-sex partners were approximately twice as likely to smoke, binge drink, and use marijuana as women with only opposite-sex partners (OR=1.41-2.78), but women with only same-sex partners were not at increased risk for these behaviors. Men with both-sex partners were less likely to binge drink (OR=0.54) than men with only opposite-sex partners.

CONCLUSIONS

Students with same-sex experience are present at every type of college. College women with both-sex partners appear to be an appropriate target for health interventions; outreach to these students and further study of related behaviors are warranted.

Employed adolescents and beliefs about self-efficacy to avoid smoking

This paper examines self-efficacy to avoid cigarette smoking and its association with smoking and quitting behavior, peer and worksite influences, nicotine dependence, and socio-demographic variables among employed adolescents. A cross-sectional survey was used to collect data from employed adolescents ages 15-18 who worked in 10 participating grocery stores in Massachusetts. Eighty-three percent of workers (n=379) completed the survey. Results from the multivariate model indicate that daily smokers were less confident in their ability to avoid smoking than those who smoked less frequently. As nicotine dependence increased, self-efficacy beliefs decreased. In addition, as friends' encouragement to quit increased, self-efficacy beliefs also increased. Work-related variables were not associated with self-efficacy beliefs among smokers. This study suggests that smoking frequency, nicotine dependence, and friends' encouragement to quit are associated with self-efficacy to avoid smoking. Researchers may tailor interventions for daily and less-than-daily smokers, build on peer networks that encourage quitting and help smokers resist pressures to smoke, and enhance strategies for coping with nicotine dependence in high-risk situations.

Differences in sexual risk behaviors between college students with same-sex and opposite-sex experience: results from a national survey

The goal of this study was to identify differences in the sexual health behaviors (condom use and number of sexual partners) between college students with same-sex sexual experiences and those with only opposite-sex partners. Data from a random sample of American university students were gathered as part of the 1997 College Alcohol Study. Odds ratios were estimated for consistent condom use and multiple sex partners for students with same-sex or both-sex sexual partners compared to those with exclusively heterosexual contacts. Five percent of respondents reported ever having a same-sex partner. Significant differences in safer-sex practices were found between groups. Females with both-sex experience and males with both-sex or only same-sex experiences were more likely to report multiple recent sexual partners than their peers with only opposite-sex partners. Odds ratios of consistent condom use were lower for men with only same-sex experience than among those with only opposite-sex partners. Findings have implications for sexual health education on the college campus. Consistent condom use remains low among college students. Education programs should emphasize the importance of limiting the number of lifetime sex partners, especially among students with same-sex experiences.

Social influences, social norms, social support, and smoking behavior among adolescent workers

PURPOSE

To examine the relationships between worksite interpersonal influences and smoking and quitting behavior among adolescent workers.

DESIGN

The cross-sectional survey assessed factors influencing tobacco use behavior.

SETTING

During the fall of 1998, data were collected from 10 grocery stores in Massachusetts that were owned and managed by the same company.

SUBJECTS

Eligible participants included 474 working adolescents ages 15 to 18. Eighty-three percent of workers (n = 379) completed the survey.

MEASURES

The self-report questionnaire assessed social influences, social norms, social support, friendship networks, stage of smoking and quitting behavior, employment patterns, and demographic factors.

RESULTS

Thirty-five percent of respondents were never smokers, 21% experimental, 5% occasional, 18% regular, and 23% former smokers. Using analysis of variance (ANOVA), results indicate that regular smokers were 30% more likely than experimental or occasional smokers to report coworker encouragement to quit (p = .0002). Compared with regular smokers, never smokers were 15% more likely to report greater nonacceptability of smoking (p = .01). chi 2 tests of association revealed no differences in friendship networks by stage of smoking.

CONCLUSIONS

These data provide evidence for the need to further explore social factors inside and outside the work environment that influence smoking and quitting behavior among working teens. Interpretations of the data are limited because of cross-sectional and self-report data collection methods used in one segment of the retail sector.

Cardiac arrest in medical and dental practices: implications for automated external defibrillators

BACKGROUND

To determine the need for placing automated external defibrillators (AEDs) in medical and dental practices, we identified cardiac arrests at these locations.

METHODS

Locations of cardiac arrest were abstracted from Emergency Medical Services data from January 1, 1990, through December 31, 1996. We calculated the annual incidence of cardiac arrest per type of practice.

RESULTS

There were 142 cardiac arrests in medical or dental practices. Dialysis centers had a relatively high incidence of cardiac arrest (>/=0.746 per practice annually). Cardiology, internal and family medicine, and urgent care centers had a medium incidence (>/=0.01 per practice annually). All other medical and dental practices had a low incidence (</=0.002 annually).

CONCLUSIONS

Placement of 779 AEDs in the high- and medium-incidence practices would have provided treatment for 112 patients with cardiac arrest in 7 years. To provide for the 16 cardiac arrests in low-incidence practices, an additional 1928 AEDs would be required.